Impact of pre-existing conduction abnormalities on permanent pacemaker implantation after transcatheter aortic valve replacement: A meta-analysis

Table 5 Summary of reported associations between baseline conduction abnormalities (other than right bundle branch block) and permanent pacemaker implantation after transcatheter aortic valve replacement

Ref.	n	Conduction abnormality	PPI rate in subgroup (%)	Adjusted effect estimate	Notes
Auffret et al[22] (2017)	3527	First-degree AV block	18.5%	Not independently significant in MV model	Baseline PR > 200 ms associated with higher PPI rate; not significant on multivariate analysis
Kooistra et al[24] (2020)	2804	IVCD (non-RBBB)		OR 3.3 (95%CI: 1.7-6.3)	IVCD independently predicted late PPI (> 48 hours post-procedure)
Rampat et al[26] (2017)	201	Pre-procedural block composite (1° AVB, hemiblock, BBB)		OR 2.54 (95%CI: 1.19-5.43)	Composite pre-procedural conduction disease was an independent predictor of PPI in the LOTUS cohort, alongside absence of aortic valve calcification (OR 0.55)
Khawaja et al[27] (2011)	243	QRS duration > 120 ms (IVCD/hemiblock)		OR 2.1 (95%CI: 1.0-4.5)	Prolonged QRS independently predicted PPI in CoreValve cohort; not RBBB-specific
Naveh et al[21] (2017)	110	PR interval prolongation (> 200 ms)		OR 4.7 (95%CI: 1.2-18.3)	Baseline delta PR > 28 ms independently predicted long-term pacing dependency at 6-12 months
Van Gils et al[29] (2018)	291	Pre-existing conduction disease (non-RBBB)		Not reported	In Cohort A (normal baseline), new QRS prolongation (not pre-existing disease) drove PPI requirement
Pavlicek et al[19] (2023)	203	New-onset LBBB after TAVR		OR 15.7 (CI not reported)	New-onset LBBB was the strongest predictor of high-degree AV block requiring PPI in this cohort
Fraccaro et al[33] (2011)	64	Pre-existing RBBB + first-degree AVB combination	100%	Not modelled separately	All patients with both RBBB and implant depth > 6 mm required PPI; no patients without both factors did

Data extracted from narratively reported subgroup analyses and multivariable models within the included studies. No studies provided sufficient extractable comparative data for a formal pooled odds ratio meta-analysis of left bundle branch block, bifascicular block, or isolated first-degree atrioventricular block as primary predictors of permanent pacemaker implantation. Effect estimates are as reported in the original publications and may reflect crude or adjusted values. AVB: Atrioventricular block; BBB: Bundle branch block; IVCD: Intraventricular conduction delay; LBBB: Left bundle branch block; OR: Odds ratio; PPI: Permanent pacemaker implantation; RBBB: Right bundle branch block; TAVR: Transcatheter aortic valve replacement.